Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN
The subtalar joint is the joint of the heel and the talus. Subtalar joint instability has been defined as the talus bone being tilted in relationship to the heel. However, there is great controversy as to whether subtalar joint instability is a real diagnosis or if it is simply a description of lateral ankle instability. In other words, is it a problem of the talus tilting in relationship to the heel, or is it a ligament problem? If so, which ligaments? Is it a talocalcaneal interosseous ligament problem that is holding the heel to the talus, or is it a breakdown of the other ligaments described above? Is it all the ligaments?
A February 2020 paper asked the question: Does subtalar instability really exist? Writing in the journal Foot and Ankle Surgery (1), researchers wrote: “Subtalar joint instability is considered a potential source of chronic lateral hindfoot (the talus to heel) instability. However, clinical diagnosis of subtalar joint instability is still challenging. In their review, the researchers assessed the consistency of doctors using the diagnosis “subtalar instability” or other diagnostic terms to describe foot/ankle instability.
Why is this important? It is important to understand the extent of the foot problem. Why is your talus tilted or wandering? What ligaments should a doctor suspect?
What they found was doctors using a diagnosis of subtalar joint instability amid a degree of confusion. They also found that “complaints of instability can be related to subtalar ligament injuries and an abnormally increased motion of the subtalar joint. (It could be all the ligaments) Stress radiographs should be interpreted with caution and should not have the status of a reference test. (In other words, an MRI may NOT show or identify what is the true cause of the problem; it may miss something less obvious.)
Regardless of the diagnostic terms, all signs point to ligament damage.
An August 2021 paper in the Orthopedic Journal of Sports Medicine (2) describes it this way: “Subtalar instability remains a topic of debate, and its precise cause is still unknown. The mechanism of injury and clinical symptoms of ankle and subtalar instabilities largely overlap, resulting in many cases of isolated or combined subtalar instability that are often misdiagnosed. Neglecting the subtalar instability may lead to failure of conservative or surgical treatment and result in chronic ankle instability. Understanding the accurate anatomy and biomechanics of the subtalar joint, their interplay, and the contributions of the different subtalar soft tissue structures is fundamental to correctly diagnose and manage subtalar instability.”
Treating ligamentous ankle instability
Since ligaments do not heal well on their own, ankle instability quickly becomes a chronic, painful condition. It allows for destructive joint motions every time the ankle joint is used, wearing down the cartilage and causing further structural damage.
Our providers understand the need for ankle stability to prevent the long-term damage resulting from ankle instability. We work to restore the ligament integrity and strengthen the joint function. Helping to prevent continued cartilage degeneration through destructive joint motions, and allows the ankle a chance to heal.
Our research
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References
1 Michels F, Clockaerts S, Van Der Bauwhede J, Stockmans F, Matricali G. Does subtalar instability really exist? A systematic review. Foot and Ankle Surgery. 2020 Feb 1;26(2):119-27. [Google Scholar]
2 Pereira BS, Andrade R, Espregueira-Mendes J, Marano RP, Oliva XM, Karlsson J. Current Concepts on Subtalar Instability. Orthopaedic Journal of Sports Medicine. 2021 Aug 13;9(8):23259671211021352. [Google Scholar]